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Ruhlmann V, Ruhlmann M, Bellendorf A, Grueneisen J, Sawicki LM, Grafe H, Forsting M, Bockisch A, Umutlu L. Hybrid imaging for detection of carcinoma of unknown primary: A preliminary comparison trial of whole-body PET/MRI versus PET/CT. Eur J Radiol 2016; 85:1941-1947. [PMID: 27776644 DOI: 10.1016/j.ejrad.2016.08.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/19/2016] [Accepted: 08/25/2016] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim of this study is to evaluate and compare the diagnostic potential of integrated whole-body [18F]FDG-PET/MRI to [18F]FDG-PET/CT for detection of a potential primary cancer and metastases in patients suspected for cancer of unknown primary (CUP). METHODS A total of 20 patients (15 male, 5 female, age 53±13 years) suspect for CUP underwent a dedicated head and neck & whole-body [18F]FDG-PET/CT (Biograph mCT 128, Siemens Healthcare) and a subsequent simultaneous [18F]FDG-PET/MRI examination (Biograph mMR, Siemens Healthcare). Two readers rated the datasets (PET/CT; PET/MRI) regarding the detection of the primary cancer and metastases, lesion conspicuity (4-point ordinal scale) and diagnostic confidence (3-point ordinal scale). PET analysis comprised the assessment of maximum standardized uptake values (SUVmax) of all PET-positive lesions using volume of interest (VOI) analysis derived from the PET/CT and PET/MR datasets. All available data considering histology and imaging including prior and clinical follow-up examinations served as reference standard. Statistical analysis included comparison of mean values using Mann-Whitney U test and correlation of SUVmax using Pearson's correlation. RESULTS In 14 out of 20 patients 49 malignant lesions were present. The primary cancer could be correctly identified in 11/20 patients with both PET/CT and PET/MRI. PET/CT enabled the detection of a total 38 metastases, PET/MR respectively of 37 metastases (one lung metastasis <5mm was missed). PET/CT and PET/MRI showed comparably high lesion conspicuity (2.6±0.6 each), with superior assessment of cervical lesions in PET/MRI and an indicated superior assessment of pulmonary lesions in PET/CT. Diagnostic confidence was rated comparably high in PET/CT and PET/MRI (2.7±0.5 each). The mean values of SUVmax of all PET-positive lesions (PET/MRT 7.9±4.2 vs. PET/CT 7.2±3.5) showed a strong positive correlation between the SUVs derived from both hybrid imaging systems (Pearson's correlation r=0.927). CONCLUSIONS Both hybrid imaging techniques provide a comparable diagnostic ability for detection of primary cancer and metastases in patients with CUP, with comparably high lesion conspicuity and diagnostic confidence, offering superior assessment of cervical lesions in PET/MRI and potentially of pulmonary lesions in PET/CT. Furthermore, due to the significantly lower dose of ionizing radiation, PET/MRI may serve as a powerful alternative to PET/CT, particularly for therapy monitoring and/or surveillance considering the long-term cumulative dose.
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Affiliation(s)
- Verena Ruhlmann
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Marcus Ruhlmann
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Alexander Bellendorf
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Moorenstraße 5, 40225 Dusseldorf, Germany
| | - Hong Grafe
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Andreas Bockisch
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Lale Umutlu
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
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Cacicedo J, Navarro A, Del Hoyo O, Gomez-Iturriaga A, Alongi F, Medina JA, Elicin O, Skanjeti A, Giammarile F, Bilbao P, Casquero F, de Bari B, Dal Pra A. Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist. Br J Radiol 2016; 89:20160217. [PMID: 27416996 DOI: 10.1259/bjr.20160217] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Squamous cell carcinoma is the most common malignant tumour of the head and neck. The initial TNM staging, the evaluation of the tumour response during treatment, and the long-term surveillance are crucial moments in the approach to head and neck squamous cell carcinoma (HNSCC). Thus, at each of these moments, the choice of the best diagnostic tool providing the more precise and larger information is crucial. Positron emission tomography with fluorine-18 fludeoxyglucose integrated with CT (18F-FDG-PET/CT) rapidly gained clinical acceptance, and it has become an important imaging tool in routine clinical oncology. However, controversial data are currently available, for example, on the role of 18F-FDG-PET/CT imaging during radiotherapy planning, the prognostic value or its real clinical impact on treatment decisions. In this article, the role of 18F-FDG-PET/CT imaging in HNSCC during pre-treatment staging, radiotherapy planning, treatment response assessment, prognosis and follow-up is reviewed focusing on current evidence and controversial issues. A proposal on how to integrate 18F-FDG-PET/CT in daily clinical practice is also described.
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Affiliation(s)
- Jon Cacicedo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain.,2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC)
| | - Arturo Navarro
- 3 Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran Via de L´Hospitalet, Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Del Hoyo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Alfonso Gomez-Iturriaga
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Filippo Alongi
- 4 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Jose A Medina
- 2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC).,5 Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Olgun Elicin
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Skanjeti
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Francesco Giammarile
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pedro Bilbao
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Francisco Casquero
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Berardino de Bari
- 8 fESTRO Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Alan Dal Pra
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
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Su YY, Chen SS, Hsieh CH, Liao CT, Lin CY, Kang CJ, Yen TC. Defining risk groups of patients with cancer of unknown primary site and cervical nodal metastases by F-18 fluorodeoxyglucose positron emission tomography and computed tomography imaging. Kaohsiung J Med Sci 2016; 32:407-13. [DOI: 10.1016/j.kjms.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/15/2016] [Accepted: 07/06/2016] [Indexed: 12/31/2022] Open
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Ryu IS, Roh JL, Kim JS, Lee JH, Cho KJ, Choi SH, Nam SY, Kim SY. Impact of 18F-FDG PET/CT staging on management and prognostic stratification in head and neck squamous cell carcinoma: A prospective observational study. Eur J Cancer 2016; 63:88-96. [DOI: 10.1016/j.ejca.2016.05.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/17/2016] [Accepted: 05/02/2016] [Indexed: 11/30/2022]
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55
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Kazmierczak PM, Rominger A, Wenter V, Spitzweg C, Auernhammer C, Angele MK, Rist C, Cyran CC. The added value of 68Ga-DOTA-TATE-PET to contrast-enhanced CT for primary site detection in CUP of neuroendocrine origin. Eur Radiol 2016; 27:1676-1684. [PMID: 27436022 DOI: 10.1007/s00330-016-4475-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/26/2016] [Accepted: 06/16/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To quantify the additional value of 68Ga-DOTA-TATE PET/CT in comparison with contrast-enhanced CT alone for primary tumour detection in neuroendocrine cancer of unknown primary (CUP-NET). METHODS In total, 38 consecutive patients (27 men, 11 women; mean age 62 years) with histologically proven CUP-NET who underwent a contrast-enhanced 68Ga-DOTA-TATE PET/CT scan for primary tumour detection and staging between 2010 and 2014 were included in this IRB-approved retrospective study. Two blinded readers independently analysed the contrast-enhanced CT and 68Ga-DOTA-TATE PET datasets separately and noted from which modality they suspected a primary tumour. Consensus was reached if the results were divergent. Postoperative histopathology (24 patients) and follow-up 68Ga-DOTA-TATE PET/CT imaging (14 patients) served as the reference standards and statistical measures of diagnostic accuracy were calculated accordingly. RESULTS The majority of confirmed primary tumours were located in the abdomen (ileum in 19 patients, pancreas in 12, lung in 2, small pelvis in 1). High interobserver agreement was noted regarding the suspected primary tumour site (Cohen's k 0.90, p < 0.001). 68Ga-DOTA-TATE PET demonstrated a significantly higher sensitivity (94 % vs. 63 %, p = 0.005) and a significantly higher accuracy (87 % vs. 68 %, p = 0.003) than contrast-enhanced CT. CONCLUSIONS Ga-DOTA-TATE PET/CT compared with contrast-enhanced CT alone provides an improvement in sensitivity of 50 % and an improvement in accuracy of 30 % in primary tumour detection in CUP-NET. KEY POINTS • 68Ga-DOTA-TATE PET augments the sensitivity of contrast-enhanced CT by 50 % • 68Ga-DOTA-TATE PET augments the accuracy of contrast-enhanced CT by 30 % • Somatostatin receptor-targeted hybrid imaging optimizes primary tumour detection in CUP-NET.
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Affiliation(s)
- Philipp M Kazmierczak
- Institut für Klinische Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81377, München, Germany. .,Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, München, Germany.
| | - Axel Rominger
- Department of Nuclear Medicine, Ludwig-Maximilians-University Hospital Munich, München, Germany
| | - Vera Wenter
- Department of Nuclear Medicine, Ludwig-Maximilians-University Hospital Munich, München, Germany
| | - Christine Spitzweg
- Department of Internal Medicine II, Ludwig-Maximilians-University Hospital Munich, München, Germany
| | - Christoph Auernhammer
- Department of Internal Medicine II, Ludwig-Maximilians-University Hospital Munich, München, Germany
| | - Martin K Angele
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilians-University Hospital Munich, München, Germany
| | - Carsten Rist
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, München, Germany
| | - Clemens C Cyran
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, München, Germany
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Pena Pardo FJ, García Vicente AM, Amo-Salas M, López-Fidalgo JF, Garrido Robles JA, de Ayala Fernández JÁ, del Saz Saucedo P, Muñoz Pasadas M, Soriano Castrejón A. Utility of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome: importance of risk classification. Clin Transl Oncol 2016; 19:111-118. [DOI: 10.1007/s12094-016-1511-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/09/2016] [Indexed: 12/26/2022]
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57
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Lee YH, Seo HS, Suh SI, Ryoo I, You SH, Son KR, Kwon SY, Son GS, Yang KS. Feasibility Study of a Contrast-Enhanced Multi-Detector CT (64 Channels) Protocol for Papillary Thyroid Carcinoma: The Influence of Different Scan Delays on Tumor Conspicuity. Thyroid 2016; 26:726-33. [PMID: 26959312 DOI: 10.1089/thy.2015.0415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Recently, a number of studies have advocated the diagnostic benefit of contrast-enhanced computed tomography (CECT) in the current ultrasound (US)-based preoperative evaluation of thyroid cancer. However, no study has been conducted to optimize a CECT protocol focusing on tumor conspicuity using a multi-detector CT scanner. This study aimed at determining the optimal scan delay for increased CT attenuation differences between thyroid cancer and parenchymal background using a biphasic CECT examination. METHODS This study retrospectively enrolled 84 patients (M:F = 7:77; Mage = 44.8 ± 10.9 years) with 87 papillary thyroid carcinomas (Msize = 14.1 mm) who consecutively underwent US and CECT examination prior to surgery. In each patient, CT scanning was taken twice-once with a 40-second delay and once with a 70-second delay-using a 64-channel multi-detector scanner. After obtaining the mean attenuation value (MAV) of the thyroid cancer and the ipsilateral parenchyma by drawing regions of interest on the CECT images based on their cytopathologic results and US findings, the parenchyma-cancer differences (PCD) between the early and delayed scans were simply compared using a paired t-test. Then, the mean differences in the MAVs of the thyroid cancer and ipsilateral parenchyma (hereafter abbreviated as Group) between the early and delayed scans (abbreviated as Time) were compared after adjusting for the other factors that significantly affected MAVs, such as concentration of iodinated contrast medium (abbreviated as CCM) and size of thyroid cancer (abbreviated as Size) using a repeated-measures general linear model. RESULTS Because the ipsilateral parenchyma exhibited significantly higher attenuation on the early scan and further decline on the delayed scan compared with thyroid cancer (p < 0.001), the PCD for thyroid cancer was significantly better with a 40-second scan delay than a 70-second delay (58.8 ± 36.6 Hounsfield units [HU] vs. 40.4 ± 25.6 HU; p < 0.001). Similar results were obtained from the repeated-measures general linear model that considered the effects of CCM, Size, Group, and Time, and the interaction of Group and Time. CONCLUSION Based on this CECT study that adjusted for the effects of CCM and size on MAV, early scans (e.g., 40-second scan delay) are helpful for improving the tumor conspicuity of thyroid cancer on CECT images.
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Affiliation(s)
- Young Hen Lee
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Hyung Suk Seo
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Sang-Il Suh
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Inseon Ryoo
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Sung-Hye You
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Kyu Ri Son
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Soon-Young Kwon
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine , Seoul, Republic of Korea
| | - Gil Soo Son
- 3 Department of Surgery, Korea University College of Medicine , Seoul, Republic of Korea
| | - Kyung-Sook Yang
- 4 Department of Biostatistics, Korea University College of Medicine , Seoul, Republic of Korea
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García J, Llinares E, Reyes G, Jaramillo A, Bassa P, Soler M. Cervical lymph nodes from unknown primary tumour. Squamous cell carcinoma of tonsils related to human papilloma virus detected by 18 F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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59
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Present and future role of FDG-PET/CT imaging in the management of head and neck carcinoma. Jpn J Radiol 2015; 33:776-89. [DOI: 10.1007/s11604-015-0495-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
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60
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García JR, Llinares E, Reyes G, Jaramillo A, Bassa P, Soler M. Cervical lymph nodes from unknown primary tumour. Squamous cell carcinoma of tonsils related to papilloma human virus detected by (18)F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2015; 35:137-8. [PMID: 26337464 DOI: 10.1016/j.remn.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/20/2015] [Accepted: 07/22/2015] [Indexed: 11/15/2022]
Affiliation(s)
- J R García
- Centro PET. CETIR-ERESA, Esplugues de Llobregat, Barcelona, España.
| | - E Llinares
- Centro PET. CETIR-ERESA, Esplugues de Llobregat, Barcelona, España
| | - G Reyes
- Centro PET. CETIR-ERESA, Esplugues de Llobregat, Barcelona, España
| | - A Jaramillo
- Centro PET. CETIR-ERESA, Esplugues de Llobregat, Barcelona, España
| | - P Bassa
- Centro PET. CETIR-ERESA, Esplugues de Llobregat, Barcelona, España
| | - M Soler
- Centro PET. CETIR-ERESA, Esplugues de Llobregat, Barcelona, España
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